| NPI | 1104992338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist (Licence: AZ SLP1240) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist (Licence: IL 146002355) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2017-12-14 |